General Information
A number of physiotherapists will be involved in your post-operative care and rehabilitation with the St George Peritonectomy & Liver Cancer Unit. The physiotherapists on ICU and the surgical ward work together to provide optimum care during your recovery.
Intensive Care Unit

The Physiotherapist will see you on the day after your operation. Physiotherapy in ICU is performed usually 1-2 times a day. Following such extensive surgery and an anaesthetic, the initial focus will be on restoring good lung function, preventing complications of bed rest, and early mobilisation. The physiotherapist will assess you and provide you with exercises and equipment to help with your breathing. This may include: daily breathing exercises with an incentive spirometer (for your use only), airway clearance techniques such as huffing and supported coughing (using a folded towel across the wound to provide support) and limb exercises.

Pain relief is very important following your surgery. Physiotherapists work closely with the pain team to minimise discomfort and enable you to perform your exercises. Exercises are given to assist your postoperative recovery. None of the exercises will cause any damage.

Once you are medically stable (usually the day after your surgery) you will be helped to sit in a chair and march on the spot. This helps optimise lung function and prevents complications caused by prolonged bed rest. Getting out of bed for the first time will feel difficult and awkward since you will have many attachments (drips and drains) but you will receive assistance from the nurses and the physiotherapist. This is one of the most important steps in your road to recovery from the surgery.

From the 2nd postoperative day, your physiotherapist will start to include daily walking away from the bedside (even though you still may have many drips and drains attached), sitting out of bed for increasing periods of time, and gentle strengthening exercises. These exercises will be given in addition to your breathing exercises, which will remain very important. After such a big operation it will feel difficult to exercise and it may take some time for your strength to return. It is good to focus on the short-term goals your physio will set with you during this recovery period.

It is a good idea to continue to practice your breathing and strengthening exercise between physiotherapy sessions. Your nurse and physiotherapist will remind you also.

Surgical Ward

Once you are transferred to the ward, your physiotherapy will start to focus on improving your mobility for discharge home. There will be a continued focus on maintaining your lung function by continuing your deep breathing exercises and sputum clearance techniques such as a huff and cough.

Everyone varies in their recovery time and your physiotherapist will monitor this and work with you to help you recover. It is expected you will participate in physiotherapy daily until you are at an independent level of function. This includes getting in and out of a flatbed, walking safely and stairs if appropriate. You will also be given strengthening exercises to independently complete.

Should you have any questions please ask to be referred to the physiotherapist on the ward who can provide more information.

Physiotherapy Role

After your Peritonectomy this includes both chest physiotherapy (for your lungs) as well as mobility (walking). A Physiotherapist will see you after your operation in the intensive care unit as well as on the ward to ensure you are sitting in a chair, walking and completing breathing exercises. The information online will help you to better prepare and understand the importance of physiotherapy postoperatively.

Chest Infections

Your lungs are normally kept clean by a thin layer of mucous that lines your airways. Dust particles and germs that you inhale with each breath stick to this layer of mucous. Tiny hairs (cilia) sit underneath this dirty mucous (phlegm) and sweep it out of your lungs and to the back of your throat where it is then swallowed and disposed of. This process happens every day of your life without you even knowing about it! It is normal to produce about 120mls (1/4 of a cup) of phlegm a day.

After major surgery, however, a more than the normal amount of mucous is produced, which is too much for your normal cleaning mechanisms to deal with. Extra help is now required to clear the phlegm. This is when you need to cough or huff to get rid of it all.  If the phlegm remains in your lungs too long, it can become a growth site for bacteria and this can lead to a chest infection.

What increases my chances of getting a chest infection?
  • Being a smoker
  • Having a lung condition
  • Being unfit
  • A long operation (> 3 hours)
  • Not walking daily after your operation
  • Being older
  • Uncontrolled pain
What Happens if you get a chest infection?

If you get a chest infection after your operation you will become quite sick. You will get a fever and a bad cough, have difficulty breathing and may need to go back to the ICU to be looked after.

At worst, you could die. You will spend a lot longer in hospital and your recovery from your operation will be slower. 

What can I do to prevent a chest infection?
  • Walking and getting active as early as possible after an operation is the most effective way to prevent complications like chest infections and blood clots.
  • Regular movement also prevents deep vein thrombosis and pressure ulcers (bed sores) from developing and promotes bowel function.
  • Walking Increases your lung volumes and helps prevent and reduce any lung collapse.
  • Deep breathing exercises and coughing will help to remove phlegm and bacteria from the lungs.
  • Physiotherapy treatment after your operation is aimed at minimizing problems like chest infections and blood clots. 
Postoperative expectations
  • Start walking as soon as possible after your operation, the earlier the better.
  • Do your own breathing exercises.
  • every day to assist in re-inflating your lungs and prevent a build-up of phlegm.
  • Do your own leg exercises to prevent blood clots from forming.
Exercises to do after your operation while in hospital  

It is important to take your pain medication regularly to ensure you can participate in the following exercises during your stay.

A.  Get Out of Bed

You will be helped out of bed by a physiotherapist and nurse on the first day after the operation. Once on the ward, the physiotherapist will teach you the easiest way to get out of bed for once you leave hospital.

  1. Roll on to your side.
  2. Drop your legs over the side bed and push up into a sitting position using your arms.
  3. Keep your hands on the bed, lean forward and push up into a standing position.
B.  Get Walking

A Physiotherapist will visit you most days you are in hospital and help you to get walking safely. They will help you to walk at a pace that helps re-inflate your lungs and prevent blood clots in the legs. You will need to walk fast enough that it feels like “light” to “moderate” type of work.

You will be encouraged to walk as far as possible each time you walk with them to ensure you are improving. You may be given a frame to help you get going in the beginning and to help carry all the drips and drains you will have. The more times you go for a walk away from your bedside during the day the better it is for your lungs.

It doesn’t have to be with a Physiotherapist, once you are confident and the Physiotherapist notifies you that you are safe to do so, you can walk with a nurse, a family member or even on your own.

C.  Deep Breathing

After your operation, your lungs will be a little deflated and your breathing will be shallower than usual. This is due to a combination of reasons :

  • Use of a breathing machine called a ventilator during the operation
  • Use of pain relief medications
  • Lying in bed more than usual and not being active

It is important you do your best to re-inflate and exercise your lungs as soon as possible after the operation to reverse these changes. Breathing and coughing exercises:

  1. Take 5 slow, deep breaths
  2. Hold each breath 3 seconds
  3. Gently press your ‘cough pillow’ to your wound
  4. Cough or huff twice
  5. Repeat all of this again every hour during the day
D.  Coughing

It is very important that you clear your lungs of any phlegm. A build-up of phlegm can harbour infections and cause breathing difficulties. Due to your incision on your abdomen, it can be painful to perform a good cough. You will be provided with support for your tummy – your “cough pillow” which you can use to help reduce the discomfort. Your physiotherapist may also teach you how to “huff” which is an alternative to a cough that tends to hurt less. Alert your nurse if your pain levels are preventing you from coughing.

E.  Circulation Exercises

When in bed it is important for you to perform the following ankle and leg exercises to keep the blood flowing through your body. This helps to maintain good circulation and prevents clots from forming in your legs.